Clinical trends in Catalonia's Primary Care Setting (2018-2023) in Elderly (≥75 years) and Frail Adults with Type 2 Diabetes.

Abstract

To describe temporal changes in sociodemographic and clinical characteristics, glycaemic control, and pharmacological treatment among older or frail adults with type 2 diabetes (T2D) in Catalonia between 2018 and 2023. Two cross-sectional analyses (30 June 2018 and 30 June 2023) were conducted using the SIDIAP primary care database, covering 75-80% of the Catalan population. Adults with T2D were included. Frailty was defined using the eFRAGICAP index. Comparisons were performed in individuals aged ≥ 75 years, and those classified as severely frail. Individuals aged ≥ 75 years with T2D raised from 195,883 to 250,571, while those with severe frailty from 10,966 to 32,665. Mean age was approximately 84 years, over 60% were women, and most lived in socioeconomically deprived areas. Mean HbA1c remained stable (6.80-6.87%), around 65% achieving HbA1c < 7%. Metformin remained the most prescribed drug. Use of sulfonylurea and insulin declined, whereas DPP-4i, SGLT2i and GLP-1RA increased, especially among frail individuals. All-cause mortality declined, most markedly in the frail group (25.2% vs 6.9%, p < 0.001). Despite population ageing and increasing frailty, glycaemic control remained stable and all-cause mortality declined, supporting individualised, holistic diabetes care in older and frail adults.